{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T20:05:20Z","timestamp":1782158720649,"version":"3.54.5"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T00:00:00Z","timestamp":1534464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007747","name":"University of Utah","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007747","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR001065"],"award-info":[{"award-number":["KL2TR001065"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1R43AI126987"],"award-info":[{"award-number":["1R43AI126987"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["R01 DC005805"],"award-info":[{"award-number":["R01 DC005805"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Understanding the variation in costs of endoscopic sinus surgery (ESS) is critical to defining value. Current published costs of ESS have not identified potential sources of variation. Our objective was to analyze ESS costs to identify sources of variance that could guide value\u2010improving decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ESS cases (n = 1739) performed between 2008 and 2016 were identified from a database of 22 rural to tertiary facilities. Cost and time data were extracted from the database. Medical records were reviewed to confirm procedures. Three bilateral groupings were examined (n = 895 cases from 13 facilities): (1) full ESS (all sinuses); (2) intermediate ESS (total ethmoid, maxillary); and (3) anterior ESS (anterior ethmoid, maxillary). Cost and operative time were analyzed using multivariable gamma regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median costs for full, intermediate, and anterior ESS were $4281, $3716, and $2549 U.S. dollars (<jats:italic>p<\/jats:italic> &lt; 0.001). Median durations were 87, 60, and 58 minutes (<jats:italic>p<\/jats:italic> &lt; 0.001). Among patients with no additional procedures, those with full ESS had operative duration, total cost, and supply costs that were 1.37 (95% confidence interval [CI], 1.17 to 1.61), 1.52 (95% CI, 1.32 to 1.75), and 2.40 (95% CI, 1.76 to 3.25) times greater than anterior ESS, respectively (all <jats:italic>p<\/jats:italic> &lt; 0.001). Intermediate ESS duration at community urban facilities was 1.87 (95% CI, 1.74 to 2.02) times that of community rural facilities (<jats:italic>p<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Duration of surgery, extent of surgery, and location of surgery are sources of significant variation in the cost of ESS. These findings will assist healthcare policy makers, hospitals, and surgeons in optimizing the value of ESS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22198","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T12:49:37Z","timestamp":1534510177000},"page":"23-29","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Operative time and cost variability for functional endoscopic sinus surgery"],"prefix":"10.1002","volume":"9","author":[{"given":"Andrew J.","family":"Thomas","sequence":"first","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7026-5819","authenticated-orcid":false,"given":"Kristine A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Newberry","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Cardon","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brock","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhining","family":"Ou","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela P.","family":"Presson","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Meier","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0560-5028","authenticated-orcid":false,"given":"Jeremiah A.","family":"Alt","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Surgery University of Utah School of Medicine  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,17]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp0904131"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21482"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24135"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12901-016-0030-8"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-017-0690-5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25180"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25656"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0000000000000329"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2017.31.4452"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21697"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21872"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810391852"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21847"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21181"},{"key":"e_1_2_6_16_1","volume-title":"CPT 2014 Standard Edition (CPT Current Procedural Terminology \u2010 Standard Edition)","author":"American Medical Association","year":"2014"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21775"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24981"},{"key":"e_1_2_6_19_1","unstructured":"Bureau of Labor Statistics United States Department of Labor. 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